It's Weight Stigma Awareness Week! Are you participating?

So, I recently found out that October is pretty much the coolest month ever, what with the Fat Talk Free Week coming up and now Weight Stigma Awareness Week!

To kick off our post about these awesome initiatives, why not throw in some pictures of headless fatties:

Because fat people don't deserve to have their faces shown. They are soooo grotesque and obnoxious that we don't want to see their faces. Yuck.

Great, now that it's out of our system, let's talk a little bit about weight stigma and how it relates to public health.

This past week, we hosted Ragen Chastain of Dances with Fat, an exciting blog that talks about obese peoples' health experiences. She spoke at the School of Rural Public Health about how obesity is itself not a health concern; rather, obesity can be a symptom of an underlying health problem. In fact, you can be obese and be more healthy than someone in the "normal" weight range.

Weight is, alone, not an indicator of health. There are all kinds of unhealthy people out there in the world, and they all fall into different weight categories. The BMI was never meant to be applied to individuals, but is rather a population-based measure of body size.

I feel like I've heard or said this all before ....


Anyway, I'm glad that someone came up with this initiative. As a former Fat Person, I can attest to the fact that people treat you differently when you gain a crap-load of weight. I've had doctors tell me to just "eat less and exercise more," or "you're not trying hard enough to lose the weight." Too bad my 40-lb. weight gain in 6 months was due to a hormone condition, not my diet. Now that I'm on medication, my weight and cholesterol have dropped, and I'm healthy again.

This issue is particularly close to my heart because of my personal experiences with being chastised for being fat. I was fat because I was sick, not because I made poor health choices. But even if you are fat and unhealthy, it's no reason to BLAME someone or treat them with disrespect.

Healthy People 2020

Healthy People 2020

Check out this insightful post about Healthy People 2020 from our friends at the Disruptive Women in Healthcare blog. These gals have put together some very cogent arguments and thoughtful observations, and we're excited to share their ideas with you!

The great academic contradiction: Politics make an appearance

As the president of our public health school's student council, I am both responsible for the welfare of the student body and accountable to our faculty. That's fair. But I am experiencing a significant crisis of faith because of the contradiction between what our professors tell us and what they actually expect us to do.

At my new student orientation, I was told about the importance of "getting involved" in my community; how, as a public health professional, my unwillingness to assist others would portend career failure. I was admonished for not immediately accepting leadership roles (although I've since assumed a great deal of responsibility here at SRPH). Further, our teachers consistently tell us to improve our community awareness, involvement, and interaction to ensure future success in our career fields.

Yet, it seems that when we attempt to take these ideas for a test drive at our own school, politics get in the way. Professors think your strategic marketing plan steps on their toes. They dislike your initiatives that are aimed at breaking down the "silos" that inhibit public health from making a real difference in many community settings. They balk at your initiative, optimism, and enthusiasm. I resent this a little.

This prevailing attitude only reveals the true advocates in our midst. Despite the dissident population, I have received support from a few dedicated faculty who encourage innovative solutions to public health problems. They recognize the potential that our generation has to effect change in our world, in spite of our tech-based upbringing. I am thankful for these people.

I guess the point of this post is that I'm consistently shocked by the negativity leaders display when you do what they tell you to do. My professors want to break down barriers between departments and disciplines? When we start doing this in our student council, let us do it! We are an interdisciplinary group, and by golly, we ought to acknowledge that fact.

The imperative for change thus falls on those stalwart supporters and energetic motivators who truly want to change the face of health in our nation and world. Sure, we give lip service to innovative solutions to public health problems, but most of us in the academic establishment seem to want to spend time in our happy little laboratories drawing models and filling in charts, pondering our navels instead of actually making a difference. It seems like we're just spinning our wheels in so many ways because of political considerations.

It's going to be like this in the real world, I know, so it's almost better that we're facing it now, in school, but for a starry-eyed idealist like myself, this whole process takes a little bit of the luster out of the profession.

Tuberculosis: It's all the fashion rage!

In last night's epidemiology class, my professor said something very insightful. We were talking about Victorian era public health, and somehow beauty standards were tossed into the equation. To paraphrase, he said:

The Victorian beauty ideal, at least for Caucasian women, was thin, frail, and waif-like. This, coincidentally, described a woman with tuberculosis.

That comment sparked a massive internal dialogue for me. So much that I could barely even focus during the rest of class. It was as though all of the ridiculous beauty standards to which women are upheld were suddenly flashing before my eyes, bolstered by historical precedent. Painful beauty routines for women are ubiquitous throughout cultures and geographical distributions. These aesthetic requirements even cause us to compromise our health.

Women's pursuit of beauty could very well kill them.

The Victorians thought you looked great if you had a deadly respiratory disease. Really. That's what they considered "hot." Is it so different in other countries? Not really. The implications of this statement, aside from the obvious eating disorder concerns (which may or may not be related to "beauty," but that's another topic), are massive!

I thought about

• Foot binding: crippled women


• Genital mutilation: dehumanizes women


• Permanent makeup: tattooing our faces! ouch!


• High heels: cripple women still


• Corsets: caused us to faint and put unnecessary pressure on our internal organs


• Waxing: self-explanatory pain. Also, makes us look like pre-pubescent girls if performed on certain body parts (which is creepy!)


• Hair products: exposure to potentially carcinogenic chemicals


• Parasites: to help us lose weight (yep, seriously)


• Lysol: to make our vagina smell fresh (also, yes, seriously)

This list doesn't even include the weird devices we use:

Anyway, maybe you all already knew everything I'm writing about, but the enormity of this topic really just sank in last night. It was like getting hit with a brick wall.

I think those of us in the public health professions have a responsibility to promote healthy beauty ideals, not those that harm us. In light of the recent obesity freak-out, I think it's critical for us to maintain a skeptical perspective about what's "good for us." I'd rather be killed by Teh Dethfatz than an intestinal tapeworm designed to keep me slim and trim. Just saying.

Risky business! Are you a sensation seeker?

Much of my research and professional experience focuses upon ergonomics, workplace hazards, and traffic safety. A major component of improving public health in these realms is compliance. Well, really, that's a problem with any public health program: How do we get people to do what we want them to do? That IS the basis of our course of study, at least in the social and behavioral realm.

We generally try to avoid blaming the individual person for his or her health decisions, rather focusing on the system that fosters such choices. Systemic changes, we think, enable people to naturally make the "right" choice for themselves, or at least a well-informed "wrong" choice.

Some people, though (myself included), are just high-risk folks. I always theorize that certain professions attract social deviants:

• If police officers weren't cops, they'd be criminals.


• If chemists weren't working on pharmaceuticals, they would be making meth.


• If ski patrol wasn't bombing for avalanches, they'd be arsonists.


• If safety professionals weren't teaching safety, they'd be dead.

Here's a cool link to a self-assessment tool for determining your sensation-seeking rating (goes from "titmouse" to "adrenaline junkie").  I, consequently, fall into the highest category, which makes sense.

I feel as though I am a great public health/safety professional because I'm the most likely person to do stupid stuff. I've skied helmetless in the backcountry, ridden motorcycles at 70mph on the freeway while the driver was drunk, and raced at speeds up to 120mph on San Antonio's roads. I've worked in chemical demil facilities that had gallons of VX nerve agent in the lab hood. I have handled dangerous chemicals without gloves or protective eyewear, and I did the same with urine on more than one occasion. I SCUBA dive, ride in small planes, get on every roller coaster I see ... and yes, I've had unprotected sex. I still run with scissors (don't tell anyone). I've done it all wrong.

I have had (in the past) almost no regard for my own personal safety. Frankly, I hit age 25 and was shocked to still be around. I was lucky. Other people aren't. This is why I appreciate the importance of safety initiatives and messages; people really do get hurt. I just lived long enough to tell my story.

In other words, I am my own target audience. If you can make me change a health behavior, you can probably convince anyone.

This is a great asset, because I'm able to critically evaluate programs' ability to succeed in real life. Is the program inconvenient? Culturally insensitive? Gender-biased? Yep, I'll find any excuse to not be healthy. Which is why I'm perfect for this discipline. If I can save people from one of the horrific deaths that I narrowly avoided, then I must be fulfilling my greater destiny. And I suspect that many public health professionals can say the same.

I hope to see some comments telling me about YOUR sensation-seeking scores! It's really a fun test.

CDC's Health Out Loud ... Entertainment and public health belong together

Here at the School of Rural Public Health, we are often encouraged to think about innovative ways of including public health messages in general media. Specifically at our school, because of our proximity to the Mexican border, we often discuss telenovelas, popular soap operas that have previously been used to disseminate information to disadvantaged Hispanic populations. These are very well-received and prompt a significant change (in some cases), when paired with other public health efforts.

I be you didn't know that the exact same thing happens on American television! Check out the CDC's blog today about a new episode of "Army Wives" that addresses the topic of Traumatic Brain Injury (TBI). Link here.

Here's also a link to the actual video clip in which TBI is discussed.


Although this approach is nothing new (I've read documents dating back to the 70's that address public health in the media), it's interesting to see how issues have changed, and how they may have remained the same.

One of the biggest issues we face as public health practitioners is the continued portrayal of illness as:

• Quickly cured


• Affecting only white, middle-class patients


• Exotic and difficult to define (i.e., not diabetes ... instead, amnesia!)

This, frankly, is not what illness is in this nation. We are a group of people with chronic conditions that are fairly common. We have high blood pressure, diabetes, arthritis, heart disease ... none of which are particularly glamorous. Trauma makes for better TV, but it doesn't help Americans understand the health care system.

I have to admit that I am particularly fond of the TLC show that shows true stories from the ER; although some of the ailments are sensationalized, we get a feeling for what might actually happen in an Emergency Department, rather than what Hollywood would have us believe. Teens actually do come in after overdosing on drugs, for example, and car crashes are among the leading causes of preventable deaths for Americans in general. The TLC show portrays these events accurately, in my opinion.

In essence, I hope that we see more information dispersal like this clip from Army Wives. Although it wasn't on a major network, I think it portrayed a fairly realistic situation. We have an obligation, as public health professionals, to promote these surreptitious but effective mechanisms for social change.

In defense of innovation

I'm currently reading this excellent book by Gerald M. Weinberg called Becoming a Technical Leader: An organic problem-solving approach. This, along with some recent class experiences, has prompted me to start thinking about the real place that innovation has in the public health care realm.

Public health, unlike computer science and other technical disciplines, is unlikely to be revolutionized by that next great idea; a single spark is unlikely to ignite a flame. That attribute, however, doesn't prevent public health from the need for great and innovative ideas. Ideas that were not forged in a sterile academic test environment ... no, those ideas are inadequate. What we need in this field, what our populace deserves, is a thinking and creative workforce that creates new approaches to old problems.

I was troubled today by a response I received from a teacher during class. I quoted the 1998 book Public Health and Marketing, which asserts that public health practitioners need to adopt strategies and mindsets that exist in the marketing realm. Specifically, we are encouraged to realize that corporate marketing professionals only expect a 2-3% per annum change in purchasing behavior (note the "per annum"). In other words, public health professionals need to set more realistic expectations for mass behavior change. This seems reasonable to me, as someone who does a lot of independent research, because I have yet to see sufficient evidence that behavior change can be achieved through educational efforts.

I was thoroughly trounced, albeit politely, by my professor, who essentially laughed at me, telling me that any proposal that promised a 2-3% change per annum would be swiftly rejected for its inefficiency. Let me bring up the following points, though. For example, in a 5-year program, assuming a 3% change annually, one could effectively change at least 15% of the target market. Perhaps a 2-3% change is warranted because of the characteristics of the health problem; if we're changing 2-3% of the rates of homicide in the U.S., for example, we might have an argument for the program if it's low-cost and efficient. Furthermore, those affected by the change may have the ability to influence their community, effectively changing social norms.

There must be something wrong with me because I have the continuous faith that professors, fellow students, and the public as a whole are as optimistic and revolutionary as I choose to be. Yes, I do my public health research. I read books upon books that have nothing to do with class, but everything to do with actual implementation of public health principles.

Take, for example, the remarkable book Theory in Health Promotion Research and Practice: Thinking outside the box, by Texas A&M's own Patricia Goodson. I won't go into detail about the book (since I'm honestly not done reading it), but the title alone should make us stop and question our motives in this field. Thinking outside the box. Theory does have its applicability, and evidence-based public health practice is important, but our field must also be receptive to the radical and weird ideas that just might change the world.

Why are we stumbling around within our profession when so many questions have been answered by research in other disciplines? We have a problem with our marketing strategy ... why don't we look at marketing research to fix the problem? There's a reason that the big corporations are dwarfing our public health efforts ... they have the resources to hire the best and the smartest campaign development staff. Our field seems to be sinking in stagnation and self-congratulatory angst. I'm kind of not impressed.

I am compelled by Weinberg's leadership model, which calls upon technical leaders to motivate, organize, and innovate. The overall theme of the book calls upon those who have been innovators in the past to stimulate new ideas by creating motivation and organization that supports new ideas.

As a leader in this field (which I hope to be one day), I can only say that I would be remiss if I didn't entertain some wacky approaches to public health; after all, we really have no idea what works in this field, so how can we trust the evidence we have? Goodson says that it's rather insane to think that we can imagine ourselves capable of predicting others' behavior. "Well, I raised his self-efficacy, so there must have been an improvement," we say, without understanding what those catch phrases really mean.

The point of this post, I suppose, is to request that public health academicians step down off their beautiful high pedestals and come join the rest of us in the real world, where things are messy and difficult to define. Allow us to think radically. Allow us to feel empowered to go out into the world and make changes! I don't want to work within the crappy existing framework that public health requires, and by golly, I don't have to.

I want to think critically about problems using a variety of perspectives, and I intend to apply theory from *gasp* other disciplines such as engineering, economics, manufacturing technology, and management. Get it together, folks. Public health is the ultimate conglomeration, the meeting place for all courses of study, and all should be recognized as valid. Who cares if it's theoretically supported if it works?!

Maybe I'm just a starry-eyed optimist, but so are others who really make a difference.